title: Initial thrombocytopenia as a simple, valuable predictor for clinical manifestation in acute hepatitis A.
abstract: OBJECTIVE
  Although acute hepatitis A (AH-A) is usually self-limited, the clinical manifestations can vary from mild to severe liver dysfunction. However, little is known about the simple, valuable predictors for clinical manifestation in AH-A. The objective of this study was to identify the simple clinical predictors for severe liver dysfunction and its clinical course.
  
  
  METHODS
  A total of 162 IgM anti-hepatitis A virus (HAV) positive patients were enrolled in the study. Severe AH-A was defined as a prothrombin time <40% of control activity. Various liver-unrelated and liver-related parameters at presentation were compared separately between the severe AH-A group and the non-severe group.
  
  
  RESULTS
  Mean age (+/-SD) was 27.5 (+/-7.1) years and the proportion of males was 54% (88/162). Fourteen patients (8.7%) experienced severe AH-A. Of the liver-unrelated parameters, leukopenia (<4000/microl), thrombocytopenia (<150,000/microl), and high serum C-reactive protein levels (>8 mg/l) at presentation were significant predictors for severe AH-A in a univariate analysis (p<0.05). On multivariate analysis, only thrombocytopenia was an independent predictor for severe AH-A (odds ratio (OR) 5.562, 95% confidence interval (CI) 1.153-26.834, p=0.033). Of the liver-related parameters, there were no independent predictors, as shown by multivariate analysis. The thrombocytopenia group (33%, 54/162) not only had a longer recovery time (28 days (range, 14-140) versus 37 days (20-128), p<0.001), but also more frequent complications (OR 4.632, 95% CI 1.886-11.372, p=0.001) than the non-thrombocytopenia group.
  
  
  CONCLUSIONS
  Initial thrombocytopenia may be a simple, valuable predictor for severity and clinical course in AH-A.
authors.affiliation: Department of Internal Medicine, Kangdong Sacred Heart Hospital of Hallym University Medical Center, Seoul, Republic of Korea.
authors.forename: Hyoung Su
authors.initials: HS
authors.lastname: Kim
authors.forename: Hee Seon
authors.initials: HS
authors.lastname: Kim
authors.forename: Jeong Yoon
authors.initials: JY
authors.lastname: Lee
authors.forename: Ji Sun
authors.initials: JS
authors.lastname: Jang
authors.forename: Woon Geon
authors.initials: WG
authors.lastname: Shin
authors.forename: Kyung Ho
authors.initials: KH
authors.lastname: Kim
authors.forename: Joon Yong
authors.initials: JY
authors.lastname: Park
authors.forename: Jin Heon
authors.initials: JH
authors.lastname: Lee
authors.forename: Hak Yang
authors.initials: HY
authors.lastname: Kim
authors.forename: Myoung Kuk
authors.initials: MK
authors.lastname: Jang
mesh_terms: D000208:Acute Disease; D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006506:Hepatitis A / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007970:Leukopenia / Q000209:etiology; D008297:Male; D011517:Prothrombin Time; D013921:Thrombocytopenia / Q000209:etiology*
chemical_list: D002097:C-Reactive Protein